Four Phases of CEM. (Comprehensive Emergency Management) MITIGATION RECOVERY RESPONSE PREPAREDNESS

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Edgar Goodwin
5 years ago
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1 Today s Agenda Jared A. Shapiro NYS Public Health Emergency Preparedness Representative (5 min.) Mock Survey EM Standard Tracer (5 min.) Four Phases of CEM (5min.) Top Hazards (5 min.) Top Hazard TTX (1hr 40min)

2 JC Mock Survey Tabletop exercise based on hazard identified in our HVA Discussion will center on the four phases of emergency management Participants include hospital command center staff & unit staff impacted by the hazard tested.

3 Four Phases of CEM (Comprehensive Emergency Management) PREPAREDNESS MITIGATION RESPONSE RECOVERY

4 Blizzards, Ice Storms Electrical Failure Fire Alarm Failure Mass Casualty Incidents Pandemic Flu Labor Action Mass Casualty (Hazmat) Small Casualty (Hazmat) Terrorism : Nuclear/Radiological TOP HAZARDS

5 Train Derailment Chlorine Tank Rupture w in d

6 1:30pm Reports about the accident are rapidly circulating through the hospital. Internal phone calls from people seeking information about what to do are being fielded by Security, the switchboard and the Administration. Many staff members are congregating on the east end of the building to get a birds eye view of the incident.

7 1:35pm Two individuals walk into the emergency department greeter area who are coughing, eyes tearing and complaining of tightness in the chest.

8 1:38pm Immediate Operational Period Begins (0-2 hours) Activate HICS CODE LEVEL ONE (1) Incident Commander calls Command Staff to Hospital Command Center SLCH emergency room receives word of multiple casualties

9 EOP Activation Impendin g Unexpect ed Event Activate the EOP Notifications LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 Alert/Notify Minor Impact Moderate Impact Major Impact

10 HICS-Command Staff Incident Commander Rob Ross Emergency Management Specialist Bill Mangieri Liaison Officer Jim Montgomery Public Info Officer Judi Stokes Safety Officer Keith Van Vlack MED/Tech Specialist Coordinator Joe Surace

11 1:40pm Newburgh Fire Chief orders the isolation of hot zone and the initial evacuation of residents for ½ mile in all directions. SLCH is positioned 0.96 miles from epicenter of hot zone. Newburgh Fire Chief orders critical infrastructure assets (Fire,Police,Hospitals) to shelter-in-place. Buildings close to the accident area may be susceptible to airborne vapor contamination, The Fire Chief recommends HVAC system manipulation to protect against potential air contaminants.

12 1:50pm The first patients transported by ambulance arrive with severe pulmonary edema. The EMT is also complaining of a burning sensation around eyes and the lips. Seven additional patients transported by Ambulance include (2) Firefighters, (2) Police Officers and three pedestrians complaining of difficulty in breathing.

13 2:00pm Activate HICS CODE LEVEL THREE (3) Call Section Chiefs to Hospital Command Center On-scene IC confirms multiple casualties being transported to SLCH ED. Fire Department sets up gross decontamination area upwind of incident FD cannot guarantee total decontamination of victims before arrival into the ED

14 HICS- Section Chiefs Incident Commander Rob Ross Operations Section Planning Section Logistics Section Finance Section Mike Pascale Jane Lake Kevin Ronk Jean-Marie Cassidy

15 Casualty Care Group Unexpected arrival of multiple casualties Incident notification received in the ED from public safety source indicating the impending arrival of multiple patients from an incident Outbreak of a disturbance, fire, or unusual situation in the ED

16 2:15-2:30pm Nine walk-in patients enter the Emergency Room greeters area who heard of a chemical release and want to be evaluated. Second wave of victims arrive at the ED via Ambulance transports. Eleven patients with symptoms associated with chlorine poisoning.

17 2:40-3:00pm Approximately 30 plus patients present themselves at the ED seeking treatment. At least a dozen patients who claim they were at the scene of the incident seek treatment through the main lobby.

18 3:00pm St. Lukes Cornwall Hospital Marketing Department receives a call from WCBS radio inquiring about the status of patients arriving to the hospital from the train accident.

19 3:15pm Supervisors are reporting several phone calls from 2nd shift staff asking if it is safe to come to work. Media reports of a toxic chemical release at the site of the rail accident have raised concerns of night-time staff for their own safety. An unusual number of support staff have called in sick.

20 3:20pm Activate Section Chiefs Support Staff Escalate CODE HICS LEVEL FOUR (4) Approximately 60 walk-in patients are outside the ED lobby area seeking medical treatment. Security has ordered a lockdown of the facility to better manage the high volume ingress of patients. Some patients outside begin to become disruptive and seek to enter the ED through the Ambulance entrance where decontamination of arriving patients is being conducted.

21 HICS-Operations Operations Chief Mike Pascale Hazardous Materials Estrella Adamczyk Medical Care Dr. Jelalian/Designee Casualty Care Group Medical Staff Yulia Kennedy Infrastructure Dennis Genoski Security Bob Childress

22 HICS-Planning Planning Chief Jane Lake Resources Unit Leader Sue McKean Personnel Tracking Manager Helen May Situation Unit Leader Renee Feenaghty

23 HICS-Logistics Logistics Chief Kevin Ronk Food & Water Unit Leader George LaMar Support Branch Director Employee Health Unit Leader Family Unit Leader Lynne Hobler Ellen Perran

24 HICS-Finance Finance Chief Jean-Marie Cassidy Time Unit Leader Procurement Unit Leader Compensation/Claims Cost Unit Leader

25 3:40pm News Media are outside the front lobby attempting to interview Security personnel who are directing nonessential people away from the hospital.

26 3:45pm There are 16 ambulances waiting in line on Dubois Street to egress accident victims. One patient is reported to have died in the Ambulance waiting for treatment. Cornwall campus is experiencing similar delays with 21 patients waiting for treatment.

27 4:00pm Many family members of victims are arriving at Newburgh Campus seeking information about their loved ones. The volume of family members seeking information drives a need for a family assistance center.

28 4:30pm Four Decontamination Team members are experiencing heat stress and fatigue associated with operating in protective clothing and respiratory protection

29 5:00pm Due to the specific nature of chlorine exposure, it is imperative to bring in relevant expertise to handle treatments of multiple victims.

30 8:00pm Many of the day-shift staff are showing signs of fatigue. Both critical and noncritical support functions need replacements or rest and/or relaxation periods. Food and Water support for staff members becomes an issue.

31 9:00pm City of Newburgh Fire Chief declares the fires have been put out and the rail car containing chlorine gas has been sealed. There are still residual levels of chlorine gas in low lying areas near the river. Evacuation orders for ½ mile area of all non-essential businesses and private households are still in effect.

32 10:00pm Emergency Department still experiencing heavy volume associated with the chlorine release. So far, The ED has treated approximately 70 patients and admitted 4 patients for advanced treatment. There are still 40 patients waiting for treatment. There are 20 patients outside the ED inquiring about the incident.

33 11:00pm The primary supportive care option for chlorine exposure is oxygen. The hospital is in need of more portable oxygen tanks for victims.

34 Wednesday April 8th 1:35am Extended operational period 12+ hours begins IC briefs command staff & section chiefs PIO continues patient information center LO coordinates integrated response with outside agencies Safety Officer monitors decon operations with Chemical Medical Specialist

35 2:00am On-Scene Incident Commander determines non-existence of vapor hazard area outside the initial isolation area of 800 feet from the incident s epicenter. A communication is received through the SLCH Liaison Officer recommending shelter-in-place posture be relaxed.

36 4:00am City of Newburgh Police have established an incident control point on Dubois Street to regulate traffic coming near the hospital. Only emergency personnel and hospital staff are permitted to enter hospital parking lot. Cardinal Health attempts to make a routine morning delivery of medical supplies but is denied access.

37 6:30am Extremely high volume in the ED. Patients arriving complaining of tightness in the chest and difficulty in breathing. Estimated wait time is 8 hours.

38 7:00am Additional Nursing Staff is needed to support the surge capacity. Nurses who were scheduled to be off can come in but are having trouble getting child care

39 1:35pm Extended Operational Period 24 Hours Hospital Incident Commander provides briefing to Command Staff and Section Chiefs. ED volume has decreased steadily all morning, wait time is cut in half to 4 hours. IC initiates demobilization and system recovery checklists.

40 Recovery- Command Staff Incident Commander- responsible for overseeing recovery operations Public Information Officer- final briefings to media/family/staff Liaison Officer- prepare a summary of status of hospital and disseminate to command and general staff and outside agencies. Safety Officer- oversee facility decontamination and declare facility safe to conduct normal operations.

41 Recovery- Section Chiefs Operations- manage decontamination of the facility and restore patient care and facility to normal operations. Planning- finalize incident action plan and demobilization plan, compile final report of incident and ensure archiving of incident documentation., write afteraction report and corrective action plan. Logistics- provide for behavioral health services for staff and patients, provide for equipment/supply repair or replacement, provide on-going support to injured staff or family of deceased staff. Finance- calculate increased costs, employee overtime, procurement costs. Submit documentation to external authorities for reimbursement or other assistance.

42 HICS CODE ALERT DRILL Cancelled Dial 66# to cancel

HAZARDOUS MATERIAL SPILL

HAZARDOUS MATERIAL SPILL SCENARIO A five-gallon holding reservoir for xylene ruptures and spills in an area within your laboratory. The technician in the area attempts to contain the spill by throwing towels over the product.